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funny right here.
I wouldn't be opposed to a single payer clinic system that basically replaced the General Practicioner. Give the med students the option of free med school in exchange for X number of years working for the clinic at a reasonable salary for a reasonable amount of time (ten years??) meanwhile they could pursue a specialty if they chose to for their after clinic years. Have HSA's and catastrophic insurance for stuff exceeding clinic care. We still need to address drug costs. I have no problem with the drug companies recovering R&D costs plus profit but the exclusive price gouging period before generics become available is way too long for most drugs.
funny right here.
Last time I went to FP doc, they wanted to run an EKG on me. I asked why and how much would it cost. They said I qualify (based on age) and it would cost me nothing - I guess it's part of the routine labs ACA allows them to run. There is nothing wrong with my heart, no history of it in my family, all my heart/cholesterol/bp #s are excellent - complete waste of money - just because they can run it and get paid - all it does is drive up the cost for next year's premiums. This is the kind of thing that single payor would encourage. Conversely, with the catastrophic insurance/HSA - no way would that EKG even be considered - prefer to save my HSA $ for long-term care premiums.
That's only partially true. Even in countries where obesity is not an epidemic like here, most people still die of heart disease, etc. Then you have things like cancer, that, except for rare episodes like smoking, they're largely out of a person's control. There's no country that has a life expectancy 15+ years better than another strictly due to "personal decisions". That's why it's kind that line of thinking is flawed, IMO. The real complication of talking about cost in the US is the notion of capitalism over everything else. It's way more about that mentality like rmt where "it's all about me, I don't want to pay for anybody else", even though he/she is undeniably going to be old, eventually will be dumped to the government to take care of the medical bills and at the current rate of price gouging in that industry, it's going to probably burn the life savings (if you're that fortunate to have at least some) to keep the person alive.
Except, as you say for cancer, a lot of our health problems are due to "lifestyle." My point is that we should be given a choice in how to spend our health care $ to target each individual person - not have it forced on us with one-size-fits-all policy (like ACA). Maternity benefits, birth control pills, pediatric dental and vision, EKGs - are all a waste of money for me - yet this is what ACA mandates and we pay through our nose through for. Except for some major car accident or cancer, (God willing) I plan to control my diabetes through diet/exercise and save HSA $s for what I think I'll need - long term care for when my body eventually breaks down so I hopefully won't be a burden to my kids, you or society.
People are going to have these diseases regardless, the difference is you don't pay for 40 years of treatment because the onset was at age 35 due to obesity and such.
Speaking of cancer, There is a lot of incredible medical stupidity in "fighting" cancer. Hey, if it's caught early and curable, then great. I'm all for it. But late term terminal is just that...terminal. it blows me away that people spend hundreds of thousands if not millions of Insurance/Medicare money "fighting" terminal cancer just to have an awful, totally ty quality of life for a few more months. Just realize you got handed a ty deal and die with some ing dignity. It's the only time you can do really great drugs legally.
Agreed. Death panels are the way to go, tbh.
This is what I'm talking about. I think it's a very dumb position, but I also have to respect it because there's a number of people that think alike and never really experienced anything else, so it's difficult.
One day you'll realize that when it comes to health is not all about you or your dollars. Health is one of those things that end in death and that we all go through. As DMC said, it's a system with 100% failure rate. God forbid you don't have enough to pay your healthcare bills and your kids spend their life savings because they want mama to live a little longer, and don't have to live with the "we could've done a little more". There really is more to this than you and your money.
Notice that doesn't make ACA a good law, that's not what I'm arguing. We all are already aware the vast majority of countries spend a fraction of what we spend for the same thing, be it treatment or medication. So either they're living off of us, or somebody is pocketing a lot of money. Either case is wrong (or you could argue the latter isn't, it's just capitalism at work, but then again, it'll be hard to make an argument we're not the suckers in that system), and I think it makes way more sense to address that first, before we address who pays for what.
Then healthcare in America is only for those that can afford it. A valid opinion, but then we go back to another point which is again at the center of this conundrum: profit motive vs citizen well being, and what America wants to be in regards to that. Notice that was the status quo about 50 years ago, and for some reason we decided to move in a different direction (although, I think it's always good to review these kind of decisions, albeit it's more difficult to unwind them for obvious reasons).
There's some truth to this, but as I was telling rmt, it's not always necessarily your choice, and there's emotional implications too. The topic can be more complicated than what it looks on the surface. I also wanted to agree with you on your earlier post that something needs to be done about the price of medications. R&D and what not makes sense, but when half your budget goes to free lunches for doctors to push your pill and other marketing, hmmm...
Thats not really the case. It's never that black or white. Usually when a cancer is considered terminal, people go on ho e and get comfort/palliative care. Otherwise most people try to treat the cancer if it isn't terminal or even early stage.
It's always interesting seeing non-medical people whether it's in the government or here talk about how to fix healthcare.
I had the blessing of walking my 55 year old sister through the last month or so of terminal breast cancer. I was fortunate that I hadn't bought my business partner out yet and could take off for a month plus to be with her. She had gone though the radiation etc. when she originally was diagnosed and had been cancer free for 5 years plus but it was a nasty one and metastasized. She chose not to fight a futile battle with chemo/radiation and all the disgusting side effects that go along with it just to prolong the inevitable. It was an interesting time. We drank wine, smoked a little pot, she had good ho e drugs and we just took the time for all her friends to visit and celebrate being with her. Part of the metastasisis was in her brain and she got goofy as ...she loved to shop and we would go to Target in the wheelchair with her pushing a shopping cart and throwing in for all her friends...stack it up with a couple of grand of stuff and put it on the credit card...she would forget and we would take it all back the next day...go back three days later and buy all the same again LOL. She had a blast right up until the day she stopped breathing.
Sorry to hear about your sister, CC.
Sorry about your loss. It's always difficult, tbh. I saw my uncle get devoured by leukemia in 8 months flat. This was a guy that had polio as a kid, had all sorts of motor problems, and still became a lawyer, eventually a judge, was a father and raised a family. An incredibly generous guy and a fighter through and through. There was just nothing to be done about his disease.
I don't think the two need to be bifurcated. Were it not for profit motive, R&D would slow to a crawl. Imagine the federal government doing all the R&D and approving of their own findings through the FDA, then the caregivers who are also at some GS level administering the care. Profit drives innovation so unless you expect people to suddenly change and be as philanthropic as their blogs make them out to be, we have to work with the current mindset of profit first. Even the billionaires got rich before delving into philanthropy.
Citizen well being is first and foremost up to the citizen. If we could be fixed for free regardless the ailment, why would we ever alter our lifestyles? That's a reductionist argument against the current ACA, because we cannot be fixed of all ailments but we can live sloppy and still have the effects buffered by medical care.
It makes no difference whether "we" decide one way or the other, the profit motive drives the train and we are passengers.
You don't talk to mechanics or bodyshop folks about fixing car insurance issues. Doctors aren't experts at managing healthcare from a financial standpoint, that's what administrators are for.
There hasn't been much innovation going on in the pharmaceutical industry in the last few decades. They've mainly delivered slight variances on existing drugs to make them marginally better. Much of the money they spend on R&D goes to paying doctors to validate the effectiveness of a product and paying to keep exclusive rights and evergreening the few cash cows they have left.
Not sure what's funny about that. You threw out an Econ 101 take, the profit motive drives innovation, when it's clear you don't have much understanding of what's been going on in the industry the last 20 years.
You must be a tweener. You throw out a term like "past few decades" as if it means back to 2006. This is just another topic you know nothing about and just want to interject. Let's cut to the chase already and say you aren't that interested in it and I care too much and you exposed me.
I know that the industry has become extremely risk averse over the last 20 years or so and pharmaceutical companies spend much of their R&D budget on tweaking existing formulations to get slight better drugs and evergreening existing patented drugs. Feel free to refute my claim by naming all of the innovative wonder drugs the industry has produced.
How about just the ones that have received FDA Breakthrough Therapy designation just in 2016
GRAZOPREVIR
ELBASVIR
PALBOCICLIB
CRIZOTINIB
VENETOCLAX
CABOZANTINIB
PIMAVANSERIN
LENVATINIB MESYLATEL
NIVOLUMAB
ATEZOLIZUMAB
SOFOSBUVIR
VELPATASVIR
CANAKINUMAB
LUMACAFTOR
IVACAFTOR
Almost all examples of variations of existing medications. The reality is new innovation is expensive and risky. And with regard to the breakthrough therapy designation:
.Four years into the US Food and Drug Administration’s (FDA) breakthrough therapy designation program and at least one prominent agency official is raising some questions about the transparency of the program and whether the drugs and biologics approved under it are as transformational as the “breakthrough” tag might suggest
http://www.raps.org/Regulatory-Focus/News/2016/06/30/25250/Breakthrough-Therapies-FDA-Official-Calls-for-More-Transparency-on-Designation-Requests-Denials/
That's quite a shift from saying "there hasn't been much innovation going on in the pharmaceutical industry in the last few decades" to saying "where are the wonder drugs?". It's the FDA that's become more risk averse. Drug companies waste billions trying to push through that red tape even for products that have no negative consequences considering the alternative is death for users.
The concept of low hanging fruit seems to escape you as well. I suppose there has been no automotive innovation since the automobile was invented, since it's just modifying the existing auto from year to year.
Not really. I qualified my comment on innovation with "They've mainly delivered slight variances on existing drugs to make them marginally better."
So has R&D slowed to a crawl? Your initial claim was that R&D would slow to a crawl absent the profit motive. My argument is that we are not getting good ROI on pharmaceutical companies' R&D because the profit motive discourages innovation of new ideas as they are risky and expensive. Instead, they're protecting profits by raising prices on patented drugs while delaying the expiration of drug exclusivity wherever possible and even paying generic drug makers to not develop generic versions.
Not lost on me at all. It's fine, but it's pretty much all pharmaceutical companies are doing which is my point.
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